Provider Demographics
NPI:1952859282
Name:MCCOMB-DIPESA, LAURA CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHERINE
Last Name:MCCOMB-DIPESA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 BERGEN ST
Mailing Address - Street 2:212
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-7444
Mailing Address - Country:US
Mailing Address - Phone:410-241-1506
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:718-232-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082450-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical